Case Study: Nurse Lapish

Some of the challenges she describes and had faced as a new graduate was the pace. She says it is not easy for a new nurse to keep up with more experienced nurses. She felt that sometimes nurses are not good at accepting new nurses and sort of, “eat their own.” Nurse LaPish is thankful for her med-surge experience and the one-fifteen ratio she had gotten used to had prepared her for the pace of emergency medicine. The common lack of faith in themselves that nurses sometimes experience can make the transition difficult. Learning as you go, patient by patient is difficult to navigate as a new nurse. These examples she pointed out reminded her of two experiences she found herself in as a new nurse. The first recollection was when she was working
Nurse LaPish described the nursing process as happening simultaneously a constant circle something you keep doing when you are helping a patient. As a nurse, you perform lots of different kinds of assessments and as a triage nurse in the ER you do an across-the-room assessment. The nurse asks themselves, how is the patient walking into the room? What do they look like, how is their color? How is their breathing? Lori said you can tell so much just by an across the room assessment. She mentioned that there are head-to-toe assessments. As well as a focused assessment that she described an example of a pediatric trauma coming in and she does a primary assessment including checking the patient’s airway/breathing, circulation, and neuro. Once these things are assessed and stabilized then she does a secondary assessment as she turns the patient over to visualize and inspect the patient to obtain more information. She went on to say in reference to diagnosing, you are always in your head thinking where something might go. A patient coming in clutching their chest is pale and diaphoretic… are they having a heart attack is what you should be thinking. Someone comes in with shortness of breath and wheezing, you ask yourself, is it asthma? So when you are looking for the nursing diagnosis after your assessment you are thinking asthma you then ask yourself is their oxygen greater than 92%? What is the patient’s work of breathing? Are they tripoding? Do you hear audible wheezing without the stethoscope? What type of a cough, productive cough, are they bringing anything up? How is their color? Is the capillary refill less than two seconds or greater than two seconds? After answering these you determine your nursing diagnosis is ineffective breathing pattern related to asthma or wheezing. Moving onto the plan for this diagnosis, according to Nurse LaPish, you ask do I need an O2 order? Do I need to get an albuterol breathing treatment for my patient? Do they need